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When prostate cancer develops, however, this androgen fuel contributes to tumor growth and progression.

For example, if a man had only one or two bone lesions, but no pain and no risk to the spinal cord, was there any benefit to waiting until he actually experienced pain from the cancer before beginning treatment?

Most studies that have looked at this question, however, concluded that starting hormone therapy early on, right after discovery of metastases, achieved better outcomes, even in men whose disease had spread only to the lymph nodes. The Effect of Androgen Deprivation and Radiation Therapy on an Androgen-Sensitive Murine Tumor: An In Vitro and In Vivo Study.

And while hormone therapy is not a cure, in that it can’t eliminate prostate cancer completely, it often extends life for many years.

By reducing testosterone levels, hormone therapy can shrink a prostate tumor and its metastases and slow further progression of the cancer for so long that sometimes a man with this disease dies of something other than prostate cancer.

For example, one small but often-cited study, published in 1999 in the found that 77% of men who had prostate cancer with lymph node metastases and chose to undergo hormone therapy were still alive and had no recurrent disease roughly seven years later, as compared with only 18% of men who decided to forgo hormone treatment until the cancer spread to bones or lungs. Although we don’t understand this phenomenon completely, animal studies suggest that a dose of radiation is more effective at killing cancer cells when given in the setting of androgen deprivation.

A more recent analysis by the same group of researchers found that these trends held up over time (see Table 1). Short-Term Androgen Deprivation and Radiotherapy for Locally Advanced Prostate Cancer: Results from the Trans-Tasman Radiation Oncology Group 96.01 Randomised Controlled Trial. One leading theory about why this occurs is that the combination of radiation therapy and hormone therapy somehow activates the immune system, so that immune system cells attack and kill cancer cells.

If prostate cancer cells escape the prostate, they migrate first to surrounding structures, such as the seminal vesicles and lymph nodes, and later to the bones or, rarely, to other soft tissues.